Our Current State

The structure of the healthcare system in the United States has been fairly stable for about fifty years while the population demographics, economy, and needs within healthcare have changed dramatically at a very fast rate.  Because of this, the policy and structure of our healthcare system has not been able to stay at pace with the population changes.  So, although need for health insurance is very high, the system is not currently equipped (in its current state) to manage such. 

Our current rate of uninsured individuals is comprised of people with various motivations for not having insurance.  A great majority of these are not offered insurance through their employer and cannot afford the cost of private coverage that is not subsidized by an employer.  Others (normally those that are very healthy) may not find paying for health insurance a high priority.  And since our hospitals will triage any emergent issue, regardless of insurance coverage, many people chose to only use those services and pay the fees associated with the care.  Finally, a growing portion of our uninsured population includes immigrants that do not qualify for private or public coverage.

Recently, the U.S. has made healthcare reform a priority and the government should be doing a better job of ensuring coverage for all citizens the way that many other developed nations are able to do.  Our government spends exorbitant amounts of money on healthcare, yet we are not helping those individuals that truly need care.  Quite possibly, the allocation of these funds are not appropriated well and could be better re-apportioned to assist more people.  One possible solution to this issue is to create a national healthcare system.  However, implementing one such as the UK’s system will take time and will require a large initial monetary investment.  The current infrastructure will not be able to immediately accommodate the amount of people or need that exists in this country

Perhaps this financial requirement is another one of the reasons that the government has avoided switching to such a system.  Yet, in a world where preventative care is more valuable than simple treatments for acute illness, it is essential to take steps to ensure that all people within the nation are covered by health insurance.

IH

Outsourcing of American companies: lots of companies close their operations in US
and move overseas. The traditional blue collar jobs are vanishing and people are losing their health benefits. Creations of new job kind of in a slower pace since US technology is losing her competitive edges to newly emerging industrialized nations. Companies both new and old are cautious in expansions. Workers in low wage positions are not offered the health benefit packages and find the premiums too steep for them to pay. More people become entrepreneurs and it is increasingly costly for freelancers to obtain affordable health insurance. Some of the young people think that they are healthy and do not desire to purchase insurance in a tighter economy. In general, there is the atmosphere of contraction rather than expansion
in US outlook. Companies are trying to trim down their overhead and general public is
looking for ways to save and survive. Sadly, for the economic survival, the health care becomes casualty. This would contribute to the high 15% uninsured rate. Conversely, lacking of healthy work force lead to less productive commerce and thus creates a vicious cycle for Americans at large. In addition , I would like to add this question:

Do the US health care system adequately treat the 21st century diseases
such as cardiovascular problems, cancer etc in an efficient and
cost sensitive manner ?

Given the existing treatment plans, we see mostly rely on Chemistry and
surgery for remedy. American society is obsessed with instantaneous cure
on modern diseases regardless the cost. Fast cure is like fast food operation.
High percentage of invasive treatments plus high tuition of medical education also contribute to the rising cost in US system. Unlike Germany, US medical education is expensive and doctors are eager to make big bucks for their investments. Other factors like expensive lawsuits and
layers of administration compound the cost issue. This partly explains the highest cost of US care system and mediocre outcome. Since most illness today is environmentally related and habitually accumulated. We need to look at alternative treatment methods to become more efficient and cost sensitive. Once the cost of treatments is down, the premium will be reduced. More people will be able afford health insurance. Also they will be more enthusiastic to
co-create a healthier America since most alternative approaches are safer and often require the cooperation of people to engage in self care.

Health Care Plan Analysis

Hello All!  Here is the link to the New England Journal of Medicine which describes both John McCain and Barack Obama's healthcare plans pretty well.  Also, I felt it was one of the most objective analyses I could find.  Enjoy!

http://content.nejm.org/cgi/content/full/359/8/781

Shanelle & frustrations with the U.S Health care System

Before coming to the U.S I had thought that the health care system of America was the best in the world (I had no clue that the country I had lived in all my life, Japan, was ranked top amongst the world in their health care system!), but I soon learned that although America has well-trained doctors and advanced medical technology, the whole nature of the health care system doesn't allow for these advantages (that other countries often do not have) to allow its citizens to receive the best care. Money, power, fear and lack of understanding stand in the way of universal health coverage. But is the wall of money hungry insurance companies, businesses, physicians and conservative legislators too big to overcome? The Hoffman reading on Health Care Reform and Social Movements in the United States gave me a new perspective on where efforts need to be concentrated in order to provide all citizens of America with proper health care. Hoffman sees the lack of mass grassroots mobilization as the main reason for the failure to revolutionize the health care system in order to provide universal health coverage. He strongly believes that health reform should not be led by elitist groups or rely on research and expertise without the strong link to grassroots activism...which makes me think...should we "experts" then be focusing our efforts on rallying and educating people for health care reform instead of working amongst ourselves and others with power?

Investing in our Health

It is hard to understand why a nation that spends so much money on health care and prides itself on being the most advanced when it comes to health technology, ranks so poorly when compared to other countries. 40 million people will go uninsured this year, and the question is why? Health care is no longer seen as a service that all individuals are entitled to, but as a privilege for those that can afford it. The system is now based on series of money transactions and is highly influenced by the need to make profit. It is sad to see that health care has now become a luxury, almost as if it is an accessory that only 85% of the population has access to. This is one of the main reasons why small independent clinics are doing so well right now. They see most of the 15% of people that are uninsured. They charge them cash and are relatively inexpensive, a complete physical can cost anywhere from $70 -$90, with extra charges if urine or blood work is needed. In the long run this can become expensive, but for those individuals that are fortunate to be in good health its affordable, and they can say they went to the doctor.
In order for change to occur, the US health care system would have to undergo an extreme makeover from the inside out. Problems arise when that change is not accepted. To me investing in your health is just as important as investing in your education. Mandating and allowing equal access to health care would be an investment for the US as a whole.

Kiran Gadani- US Healthcare System

I took a class during my undergraduate studies that studied the US health care system extensively. After learning from that class that the US spends the most on health care and gets the least out of it, I was shocked. After watching the Frontline documentary "Sick Around the World", which gave the same conclusion, I was still just as shocked. How does a country like the US let this happen? Our constitution is based on basic human rights, yet we have about 40 million people that do not have the right to health and so many others that are under-insured. We rank 37th in the world when it comes to health and are number one is spending. I feel as though one of the main reasons why the US has about 15% of its population uninsured is because Americans tend not to like change and we hate having the government have control over our lives in addition to the fact that the US is a free-market system. Comparing our system to others, we have lack three things: 1) our insurance companies do not have to accept everyone and can turn down the sick and elderly 2) health insurance is not mandated and 3) the system runs on a free-market so there is no set of standard prices for medical procedures and drugs. One of the main reasons why we have people uninsured is because health care insurance is not affordable and that it is not mandated by law in addition to the resistance to change among the American public. There is no magical equation for a successful health care system--as seen in the videos, there are down falls of other health care systems as well. However, it is the weight that the benefits carry that must out way down falls which will make a system successful in its own right. To effectively solve the problems of the US health care system, we must give up some benefits in order to better the health of the citizens and effectively use our financial resources.

Get Em' High

S.S.Patel reporting live on remote access for the latest input on why our beloved country is satisfy and/or content with having roughly 15 percent of the population to be uninsured. Well let us start with the U.S. mind state for the last couple years, which were not in healthcare realm. I think the main concern for the last couple years is fighting terrorism due to the massive attack which led to the most lives lost on mainland America soil since the Civil War. So the government was concerned with health, but health only as a byproduct due to violence. Getting beyond 9/11, there was not really general public campaigns about health insurance. I mean yes, there may have been a few, but the mass public did not have grasp on the knowledge. I know lack of education or lack of passion is not an excuse for the public, but uninsurance wasn’t a big issue. I mean, you have school education reforms, space program to develop, and blue collar labors trying to compete for jobs, and at one point there were high approval ratings for Bush Sr. and even Bush Jr.

Life under Clinton mask the truth of Monica Lewinsky, but also the dire need for healthcare reform, which could have been the best spot to do so, due to stable economic success. Things just swept under the carpet until a pile up occurred and just burst due to the economic turmoil that we face as a nation today. This 15 percent is only seen or talked about today because of the economic trouble the nation faces. I wonder if the economy didn’t foul up under Bush Jr, would healthcare and uninsured individuals be an issue currently. My guess is probably not because our nation politics seem to always be driven to current day to day issues, and not too much of setting up a long term hold. It seems like election year is the only year when the general public care for reform or change. Or maybe Americans take to heart the phase, if is not broken, then don’t get it fix. So don’t go to the doctors unless it’s broken or impede daily or work activities. Going to the doctors is inconvenience and America frown upon inconvenient truths (until it are told by Al Gore).

Anyways, trying not to digress from the question, US allow this to happen, because it can, simply put. Other prevalent issues side curb the uninsured population. It probably wouldn’t have got this bad, if bonuses such as in England where doctors get paid for having healthy patients (taken from PBS video). It seems like in England, the doctor office is becoming the local type of pub, where people can come in to socialize. Wow, we could make a new Fall pilot similar to the classic Cheers, but instead everyone meets at the doctor office and drink of choice would be water and O2 for the elderly. But in actuality, if America could somehow adopt social insurance and be more preventive, America would not have to allow 15 percent uninsured because everyone would be covered. But again, would America be like Japan who typical resident goes 3 times often than Americans? I would hope so. It’s a double edge sword with capitalism and free market and the sword is on the back of the uninsured.

This posting was made possible by readers like you. Songs of the blog that fueled this week:

Kanye West – Champion; Kanye West, Talib Kweli, Common (photo from nike run concert thanks to Timiyin) - Get 'Em High

Yasmin Khan + The Reality of US Healthcare

The PBS Frontline video was very intriguing and thoroughly highlighted the inefficiencies of the current US health care system. The US health care system is extremely market-driven and in order for any sort of restructuring to take place, the current system has to be ready to accept some losses. The three concepts that I found most interesting that I believe the US system could in some way adapt was 1) that everyone was required to purchase health insurance and the goverment would take care of the premiums for the poor, 2) no one could be denied health insurance for a pre-existing illness and health insurance companies cannot make a profit on basic care, and 3) doctors and hospitals have to accept one standard set of fixed prices for services.

It's astounding to know that the US being the richest nation who spends the most on health care ranks so poorly in regards to health indicators and leaves over 40 million uninsured. The current system is largely for-profit and heavily influenced by economics. It seems unrealistic for the US to be able to reform the health care system similar to how Taiwan and Switzerland underwent reformation of their health care system, unless the US was willing to allow for more government control and less privatization of health care. The more time that passes without any action being taken, the bigger the mess and the more lives lost due to health care remaining a luxury to the 40 million without insurance.

Inefficiency of the U.S. Health Care System

The U.S. health care system is trapped in its inefficiency, preventing it from moving forward and insuring a greater percentage of the U.S population. It would be a logistical and bureaucratic nightmare to completely overhaul the U.S. health care system and build it from the ground up as Taiwan was able to do, as we heard on ‘Sick around the World’. Largely contributing to the U.S. system’s inefficiency is the free market in which it functions. U.S. health care is a for-profit business—unlike Great Britain’s system, which is funded by tax revenue and entirely government-owned and –operated. Functioning according to the laws of supply and demand, the U.S. system is in many ways dictated by economics. Further contributing to the number of uninsured is the for-profit nature of U.S. private health insurance, which also has say over who it will and will not cover.

Progress in the U.S. health care system is inhibited by bureaucracy. The HMO system with its gatekeepers is all about bureaucracy. And again, the predominantly privatized nature of the U.S. system is a jumbled mess when compared to the more streamlined system one finds with more government control, as in Great Britain and Taiwan, and even in the more privatized Japan and Germany.

There is a give-and-take in the U.S. system, as Sick around the World continually points out: the U.S. largely offers care of high quality (granted, to those who can afford it); clinical providers are, arguably, adequately compensated for their work. The U.S. health care system definitely has plenty of room for improvement, but I also did not want to neglect some of its positive aspects.

Posted by Sam

So I watched the frontline piece on international health care systems and found it quite thought provoking as well as revealing about what I interpret to be the American psyche.

First of all I noticed that there were some common themes among the different health care systems being analyzed. One, health care was not seen as a for profit enterprise in any of the countries. Two, no body was denied health care in any of the systems be they private or government funded. Three, doctors were not paid particularly well. Four, it was unanimous that nobody went broke or was put in undue financial burden because of medical bills. And five, both the GDP spent on healthcare and the administrative cost seemed to be around 8%.

While these are all lessons that we as Americans should take when looking to reform our health care system, I learned both by listening to the frontline correspondent and by thinking about it myself that many of these changes would not be accepted by the American People. In order to incorporate any of the ideas presented in the frontline piece the government would have to step in and play a more active role in healthcare. Whether it be providing the healthcare (UK) or mandating that people register for health care (Japan) or fixing the prices of medical procedures (Japan, Taiwan, Germany), the government needs to step in and the American people are not ready for that kind of oversight. To make these systems possible in the United States would also need to involve a paradigm shift in which the American business world can view healthcare as a necessary not for profit entity which needs to exist. Because we have a for-profit system, the bigger companies deny those who they deem as not profitable and this is where we get the 15.3% of un-insured Americans. The government does not yet see it as their responsibility to provide health care to everyone. In my opinion this could be done if we cut the overhead going to administration which is a staggering 22%! Taiwan has instituted smart cards which have all the relevant information on them and has cut the administrative fees dramatically.

To answer the question more directly, the U.S has allowed the un-insured rate to climb so high because we as a society are market based capitalists and the health care providers as well as the medical personnel like to be making money even if it is at the expense of the un insured. In fact we are making so much profit here that the Swiss drug companies make a third of their profit from American health care! Until we have a major paradigm shift in this country we will continue to allow the current un-insured rate.

To Lose or Not to Lose!

The US allows 15 percent of its population to be uninsured merely because that would mean providers would lose money (and God forbid that they lose a little money!). Those in power would rather let people suffer than to help them if it means that it would breach capitalistic ideas.

I found the videos to be very enlightening to the reasons the US has an unethical health care system. I say unethical because the system is clearly driven by money-hungry elitists who do not have the public in their best interests. The comparisons of the health care systems truly show the lack of compassion and baseness of thinking in the US. The health care system in the US is an extension the capitalistic ideas that this society is based on that leaves everyone to fend for themselves pulling other people down to lift your own self up. Our inherent fear of socialism and rewarding others “undeservedly” is the main cause for this divide in health care delivery. There has to be a shift in the moral fiber of the market-based health care system where everyone is treated equally and fairly. I think the government needs to play a more inclusive role in making sure that health care services are provided to those who need it, period.

Without having policy makers who truly desire and seek to establish a system to serve everyone regardless of economic status or other differences, then the US will never have the reform needed to help the uninsured. In the minds of the policy makers, health care must be considered a right to life and not only a privilege for those who can help increase their pocket size.

Upon viewing the 5 videos, I actually found them incredibly informative, yet concise and easy to digest.  In answering the question more broadly, I would have to say that our 15% uninsured is, in large part, due to our fierce belief in the unassailable superiority of the "free market".  Interestingly, it was shown that even in other Capitalist nations, it was admitted that what is best for the economy may not be best for health care.  The president of Switzerland himself, a conservative party member, voiced that 100% free-market health care causes you to "lose solidarity and equal access".  Further, I feel that we also seem to have a history of being a very polarized or "all or nothing" society.  This may lead many to the mistaken assumption that we either have a choice between entirely pure, free-market health care or a single government-run system, with no grey area in-between.  I thought these videos did a fantastic job of showing that is entirely false.  Just as we saw with Taiwan, you can have an immensely successful health care infrastructure based on an amalgam of alternative systems. 

Another main reason for our fierce adherence to the current system would be the profound fear in this country of all things "Red", in other words, any ideas or systems that could be interpreted as "communist" or "socialist".  While I am not aware of the depth of anti-socialism in any of these other countries, I believe just the fact that these systems are often referred to as "socialized medicine" is enough to defeat any hope of instituting a universal healthcare system in the US in the near future.  However, I found Switzerland to be one of the more intriguing examples, as they appear to have been as bitterly divided over healthcare as we are currently in the U.S.  The fact that the law was passed, even if only by the thinnest majority, in another country priding itself on staunch individualism, gives hope for a similar outcome here.

The true reason behind such a high lack of insurance in America is undoubtedly far more complex, but these were the main two reasons that leapt out at me through the PBS documentary.

Week 2 Response

The reason that 15.3% of the US population remains uninsured (with estimates of an additional 25% underinsured) is primarily due to the fact that our political leaders fail at fulfilling the needs of the population that it represents. Rates of uninsured individuals have been increasing steadily for years due to growing health expenditures and the growing dissatisfaction for HMOs. The big push for universal health care in the early 1990's was geared to provide equitable access to health care for all citizens. This policy was meant to serve the needs of the people. Unfortunately, intense campaigning by special interest groups convinced Congress not to enact this new legislation, thus leaving us in our current dilemma, with more health care costs and a staggering gap in health status between rich and poor.

Policymakers in the local, state and national levels of government are in their positions to represent us, to represent our needs. 15.3% of the population is uninsured with another 25% that are underinsured. Those figures add up to an underperforming government in my opinion. The political will and commitment to serve the people, in a bipartisan fashion, and fulfill their long-term needs is absolutely necessary. As citizens, we need to demand what we want. With so much focus on the need to protect the freedoms that our country was founded on, I think we take for granted that we need our health to enjoy any of those freedoms...

In addition, our society has progressed into a passive state with regards to health.

Posted By Claire

Compare to other developed nation's health care systems, it is obvious that U.S. systems is a market-based system. Without government regulations on costs, the price for treatment and delivery of health care is very high. The outcome is paid by its own citizens going bankrupt every year on health care systems alone.
Besides government's regulations, why is the cost so high? The cost is largely incorporated in admistrative costs, such as paper work and the time to process each patient's record.

U.S. government originally thought market-based industry will help reduce the price, like the phone or cell-phone industries. In reality, the health care industry is more complicated than it was once thought.

In contrary, market-based industry is good for some reasons. It allows health care providers to compete for better services. Hospitals can come up with their own strategies to reduce waiting time, increase customer services, and other health promoting programs. Kaiser Permanente has developed an electronic system that reduces paper work and yet allow doctors to view patient's record/ doctor visits accurately without going through questionnaire.

Overall, comparing U.S. health care systems to others, it is weak in providing effective and sufficent health care to citizens. Without U.S. govenment intervention on regulation of the price and changing the health policy, we citizens will continue paying the price.

Individual Rights

In chapter 2 of the readings this week, the text does an excellent job of comparing the society and health care system of a few different countries. Although not to in depth, the text points out the American's tie to individual rights. The book states, "due to their rugged individualism, (USA) have a tendency to elevate individual rights above the welfare of the community...The individualistic version of negative, self-centered rights lacks the social dimension found in egalitarian and communitarian societies." (pg 40).

I think it is this self-centered mindset that allows the 15% uninsured. Everyone that has health insurance is satisfied and is not willing to change their life-style and comfort to help the 15%.

Public Health Law + US uninsured

Ara’s Blog: for September 3, 2008 (week 2) Readings.

The question posed is: how can the US allow having a high number of uninsured within its population? My immediate response to this would be: its existence is embedded in the political as well as cultural infrastructure of American health development. This was briefly brought forth in Chapter 2’s reading, titled “political explanations of health policy”. I’d like to expand on my response by utilizing public health law concepts. It’s a field of personal interest and I believe these concepts would be a great foundation to build upon during the rest of the semester.

It’s the government’s responsibility to protect the health of the populations that have significant relationships established in need of provisional public health services, and that they [the government] must implement them in a manner which yields conformity (but must protect civil liberties). And this is where the difficulty arises. There are trade-offs: providing health services and protecting private/self-interests as well as civil liberties; namely, autonomy—which is the predominant cultural explanation in the demand of services.

Public health can only be achieved through communal effort. Yes, the individual can manage in attaining the basic goods in life, including medical services, but no individual can assure his or her health. Since there are many communal goods that the population has a stake in (i.e., environment, sanitation, clean air/water, safe roads/health products, and control of infectious disease), these are collective goods that can be secured when being provided and protected on behalf of populations (i.e., via government) and with the cooperative involvement of communities.

However, as much as public health is indispensable to the individual so as to provide the means to enjoy fulfilling lives and to the community so as to provide the foundation for social, political, economic growth through the subsequent social productivity, the government’s role in the provision of health services can’t be absolute. In other words, there can’t be complete guarantee of health care services. How is that so? Let’s ask ourselves:

a) How much [medical and health service provision] is enough?

b) How is it determined as to whether the resources were allocated effectively and implemented properly?

c) How do we determine whether the “Standard of health” has been reached?

d) How do we objectively define “Standard” of health, let alone, “health”?

e) Is it proper to say that a population has the “right to health”? This may be demanding an unattainable request; namely, perfect health and well-being. Instead, is it justifiable to say that society has a “right to services”?

For these reasons and more bioethical dimensions, there can’t be an absolute governmental role in health care provisions.

A challenge in assuring universal insurance is the perennial conflict of state and individual interests. While the state tries to sustain beneficence and non-maleficence, there is a conflict with the individual’s right to bodily integrity, liberty, and autonomy. So the question then becomes: What should a policy embody so as to balance such interests?

Theoretically, it should ensure the just distribution of burden, costs, and benefits. The ideal situation would be to provide the benefits to those in need, while giving the burden and costs to those that are endangering the public’s health. And even while the services are provided to those in need, that they are done justly and equitably. Unfortunately, there are two types of policies that we may encounter: under-inclusive and over-inclusive.

Under-inclusive health policies will place the benefits toward only a small subgroup of people and thereby not be able to reach everyone who may be in need of it (unjust distribution). Furthermore, it will regulate/penalize only a subgroup of people that are thought to be “Dangerous, high risk” (unjust regulation). Essentially, the cut off points for beneficial provision and regulation are too low.

Over-inclusive health policies on the other hand, will place the benefits of service to a large group of people that may not all necessarily need it (wasteful spending). Essentially, the cut-off point for distribution and regulation is too high.

With such an imbalance, what are other alternatives? Or, should there even be an alternative? Should government even bother intervening and providing health services? Is it there *duty*? Regarding health provision, the government stands on a “negative constitution”, with “no affirmative obligation” to act, or to protect; even if such aid may be necessary to secure life, liberty, or property interests.

Furthermore, judicial refusal to examine government’s failure to act, irrespective of circumstances, leaves the state free to abuse its power and cause harm to citizens. In other words, a constitutional rule that punishes government misfeasance (when the state intentionally or negligently causes harm) but not nonfeasance (when the state simply does not act) provides an incentive to withhold services and interventions.

Questions: how is inactive negligence of causing harm (direct or indirect) not the same as active negligence of causing harm (direct/indirect)? Why isn’t the former held just as accountable as the latter?

Lastly, I’d like to just make the argument of providing universal insurance on the grounds of human rights. Is health a human right? In what manner? How do we justify it as a public good? The fact of the matter is, they have mutual interactions. In that: if government doesn’t safeguard society from the violation of civil liberties, social and economic burdens will arise as well as the loss of social trust and adherence to health initiatives. Despite the fact that the protection of civil liberties entails the deprivation of such liberties from select groups of individuals, is the American society and culture willing to accept such a trade-off at the expense of others? Either answer to that question will yield the same outcome: universal insurance and protection of civil liberties can’t be attained.

And in an American culture where civil liberties are of highest priority, along with the demands of highest health services, the race for their simultaneous acquisition is never-ending....

**For further information on over-inclusive, under-inclusive policies, as well as the concept of negative constitution, please refer to:

Gostin, Larry o. Public health law: power, duty, restraint. Berkeley: University of California Press, 2000. (Chapter 1, 2, and 4).

THANK YOU for your time...

Off And Running

Welcome to the class blog...

Let's get started. Our next class focuses on the U.S. health care system to give us a point of reference as we start to explore international health system issues. We'll go over how it originated, how we got to where we are today, what it looks like today, and what works and doesn't.

But, importantly, I want us all to hit the ground running by having at least a basic working knowledge of several other health care systems, just in order to be able to see how different the U.S. system is.

I would highly recommend that you take an hour or so to watch an episode of Frontline (on PBS) that is a nice, brief documentary on the U.S. health care system in relationship to the health systems of five other countries: the U.K., Japan, Germany, Taiwan, and Switzerland. It is available at the following link below and can be watched for free in sections.

--Sick Around the World

My question for you is, having seen a little snippet of other systems, why do you think the U.S. (one of the richest nations in the world) allows 15.3% of its population to be uninsured?

-Dr. Stevens

p.s. Did you remember to sign up for the e-newsletters from the various policy organizations?